Background
This study aimed to investigate prevalence of lean metabolic associated fatty liver disease (lean MAFLD) in people living with HIV(PLWH) and the value of ten diagnostic models in MAFLD among PLWH.
Methods
Transient Elastography (Fibroscan), Controlled attenuation parameter (CAP) and ultrasonography were performed among PLWH. MAFLD was defined by the 2024 revised edition of the Chinese guidelines for prevention and treatment of MAFLD. Lean MAFLD was defined as a BMI＜24kg/m2 in patients with MAFLD. The SteatoText (ST), fatty liver index (FLI), NAFLD-liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), index of NAFLD(ION), ZJU index, NAFL screening score (NSS), K-NAFLD, visceral adiposity index (VAI) and Lipid Accumulation Product (LAP) were evaluated. The area under the receiver operating characteristic (AUROC) curve was used to evaluate the performance of them for diagnosing MAFLD.
Results
Among the 361 PLWH, 141 were diagnosis with MAFLD, with a prevalence of 39.05%. Out of these 361 patients, 111 were overweight (BMI≥24kg/m2), and 250 were non-overweight(BMI＜24kg/m2). MAFLD affect 58(23.2%) in 250 lean PLWH. Among the overall population, the NSS had the highest AUROC of 0.887, followed by FLI (AUROC =0.880), ZJU (AUROC = 0.873), LAP (AUROC = 0.849), and ST (AUROC = 0.847). ION had the lowest AUROC with value of 0.744. In the non-overweight population, the AUROC of NSS was 0.868, suggesting moderate diagnostic value. However, among overweight or obesity population, it showed limited diagnostic value with AUROC of 0.736.
Conclusions
We found a non-negligible prevalence of MAFLD in lean PLWH. Models established on chemical and metabolic indicators provide no advantage for MAFLD diagnosis in PLWH, especially for overweight patients. PLWH should be prioritized for inclusion in global trials of MAFLD management.
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